Provider Demographics
NPI:1871338640
Name:TRICOUNTY FAMILY JUSTICE CENTER
Entity type:Organization
Organization Name:TRICOUNTY FAMILY JUSTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:505-718-7300
Mailing Address - Street 1:2534 RIDGE RUNNER ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-718-7330
Mailing Address - Fax:505-718-7373
Practice Address - Street 1:2534 RIDGE RUNNER ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-718-7330
Practice Address - Fax:505-718-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty